Drug Toxicities, Bilirubin, Kernicterus, Dumping/HH, Hyperkalemia

Question 1

Used for Bipolar, specifically for manic episodes but not for the depression

What it its
Therepeutic level:
Toxic level:

Answer 1

LITHIUM (antimania drug)

Therepeutic level: 0.6 to 1.2
Toxic level: > 2.0

*Notice gray area: 1.3-2

Question 2

Used to treat A-Fib and CHF

What are its
Therepeutic level:
Toxic level:

Answer 2

LANOXIN or DIGOXIN

Therepeutic level: 1 to 2
Toxic level: >2

Question 3

Used for muscle spasm relaxer for the airway
- compound of the bronchodilator theophylline
*actually NOT a bronchodilator, only relaxes spasms
B2 -> relaxes spasms
*bronchodilators should be given AFTER antispasmotic to relax the airway first THEN dilate

What is its
Therapeutic level:
Toxic level:

Non-therapeutic level:

Answer 3

AMINOPHYLLINE

What is its
Therapeutic level: 10 to 20
Toxic level: > 20

Non-therapeutic level: < 10… if it is ot therapeutic, increase dose of medication, and assess for compliance

Question 4

Seizure medication

What is its
Therapeutic level:
Toxic level:

Answer 4

DILANTIN (PHENYTOIN)

Therapeutic level: 10-20
Toxic: level: >20

Question 5

Breakdown product of Red Blood Cells

What is its
Elevated level: ___________________
Toxicity: _________________

When do physicians want to hospitalize these newborns?
Level: __________________

Answer 5

BLILIRUBIN

Elevated level: 10 to 20
Toxicity: >20

*always tested in the newborns on the NCLEX

When do physicians want to hospitalize these newborns?
Level: when the bilirubin level is 14 to 15

Question 6

When there is excess bilirubin in the brain
It occurs when bilirubin level in blood gets _____________

In the brain, it may cause aseptic (sterile) meningitis or encepalopathy (don’t need to know)
IT CAN BE DEADLY

Answer 6

Kernenicterus

> 20

Question 7

• Position the newborn assume due to irritation of the meninges from kernicterus
• Presentation: hyperextended posture … (Is a medical emergency)

Answer 7

Opisthotonoc

Question 8

In what position do you place an opisthotonic newborn?

*Opisthotonic: Position the newborn assume due to irritation of the meninges from kernicterus

Answer 8

Put them on the side

Question 9

It is when the newborn comes out yellow, something is wrong

Answer 9

Pathologic jaundice

Question 10

It is when the newborn turn yellow 2 to 3 days postpartum, that’s ok

Answer 10

Physiologic jaundice

Question 11

What are gastric emptying problems and are opposites

Answer 11

Dumping Syndrome vs. Hiatal Hernia

Question 12

• Regurgitation of gastric acid upward or backward into esophagus
• “Like a cow with 2 stomachs,” gastric contents go in wrong direction at the correct rate
• S/Sx of hiatal hernia is similar to GERD (Heartburn and indigestion)
• S/Sx of hiatal hernia = S/Sx of GERD when LYING DOWN AFTER A MEAL (THIS DISTINGUISHES ____ from GERD)
- in other words, Heartburn, Indigestion on lying down after eating

*it is GERD after you lie down and eat

Answer 12

HIATAL HERNIA

Question 13

What is the treatment of HIATAL HERNIA

Answer 13

1. Elevate HOB (head of bed) during and 1 hour after meals
2. Increase the amount of fluids with meals
3. Increase the amount of Carb content

• these cause the stoamach to empy quickly so its content doesn’t back up
  0High-ata Hernia…. Everything high

Question 14

• Gastric contents are dumped too quickly into duodenum
o Right direction but at wrong rate • S/Sx of dumping syndrome
o Drunk: Staggering gate, impaired judgment, labile—all blood gone to gut
o Also get Shock: cold/clammy, tachycardia, pale
o Now add Acute abdominal distress: n/v, diarrhea, cramping, guarding, borborygmi,
bloating, distention • Dumping syndrome = Drunk, Shock, Acute Abdominal Distress (r/t to dehydration)

Answer 14

Dumping syndrome

Question 15

What are the S/Sx of dumping syndrome

Answer 15

o Drunk: Staggering gate, impaired judgment, labile—all blood gone to gut
o Also get Shock: cold/clammy, tachycardia, pale
o Now add Acute abdominal distress: n/v, diarrhea, cramping, guarding, borborygmi, bloating, distention

Question 16

Drunk + Shock

Answer 16

Hypoglycemia

Question 17

Drunk + Shock + Acute abdominal distress

Answer 17

Dumping syndrome

Question 18

What is the Tx of Dumping Syndrome?

Answer 18

•Can do 3 things, as shown below
1. Lower HOB (head of bed) during meals and turn pt on the side
2. Decrease the amount of fluids 1 or 2 hours before or after meals
3. Decrease the amount of Carb content
o These 3 things prevent the stomach to empty quickly or dump its content into the duodenum
• Dumping syndrome … Everything low

Question 19

• Protein does the opposite of carbohydrate
• Protein bulks gastric content, takes longer to digest, and moves slower through the gut
• Therefore, give

Do we give low or high protein in HIATAL HERNIA?

Answer 19

LOW

Question 20

• Protein does the opposite of carbohydrate
• Protein bulks gastric content, takes longer to digest, and moves slower through the gut
• Therefore, give

Do we give low or high protein for DUMPING SYNDROME?

Answer 20

HIGH

Question 21

Go in the same direction as the prefix, except for HR and urine output (UO), which go in the opposite direction

Answer 21

Kalemia(s)

Question 22

What does HYPOkalemia look like

Answer 22

Symptoms go low with hypo, except UO and HR

Question 23

What does HYPERkalemia look like?

Answer 23

Symptoms go high with hyper, except HR and UP

Question 24

List the S/Sx of Hyperkalemia

Answer 24

Brain: seizures, agitation, irritability, loud down
Heart: tented T waves, ST elevated, decrease HR
Bowel: diarrhea, borborygmi
Muscle: spasticity, increase tone, hyperreflexia (3+, 4+)
UO: down (oligouria)
Lungs: Tachypnea

Question 25

WHAT IS THE Tx OF HYPERKALEMIA

Answer 25

KAYEXALATE

Question 26

What are S/Sx of Hypokalemia

Answer 26

Lethargy, bradypnea, paralytic ileus, constipation, muscle faccidity, hyporeflexia (0, 1+) TACHYCARDIA (HR is up) POLYURIA (UO is up)

Question 27

WHAT IS THE TX FOR HYPOKALEMIA

Answer 27

PO K LYTE Replacement *K absorbs best via GI*

Question 28

Your patient has hyperkalemia, select all that apply A. Adynamic ileus b. Obtunded c. 1+ reflex d. Clonus (irritable) e. U wave f. Depressed ST g. Polyuria h. Bradycardia

Answer 28

D. H. *hyperkalemia has tented T wave, T wave peak

Question 29

What does Calcemia(s) look like

Answer 29

GO IN OPPOSITE DIRECTION AS THE PREFIX

Question 30

Symptoms go (high or low) ______________ with hypocalcemia

Answer 30

HIGH

Question 31

Symptoms go (high or low) ______________ with hypercalcemia

Answer 31

LOW

Question 32

What to do with kids w biluribin of 11-13

Answer 32

Sunlight, Fluids

Question 33

What bilirubin level does doctors consider bringing newborns to hospital

Answer 33

14-15

Question 34

Gastric problem where The direction is the problem, at the correct rate

Answer 34

Hiatal hernia

Question 35

Gastric contents dump too quickly to the duodenum

Answer 35

Dumping syndrome

Question 36

Is it hiatal hernia or gerd? A nurse get up in the morning skips bfast passes meds does tx, at 11:00 have epigastric pain, indigestion, etc

Answer 36

GERD

Question 37

Gerd or hiatal hernia? Nurse gets home at 7pm eats and lies down. later develops epigastric pain, etc

Answer 37

GERD

Question 38

What are s/Sx of Hypercalcemia

Answer 38

Bradycardia, bradypnea, flaccid, hypoactive reflexes, lethargy, constipation, etc

Question 39

What are S/Sx of Hypocalcemia?

Answer 39

Agitation, irritability, 3+ or 4+ reflexes, spasm, seizure, tachycardia, Chvostek sign (tap the cheek), Trossseau (inflate BP cuff)= hand spasm with BP cuff, etc

Question 40

For potassium, pick answers related to __________ problems

Answer 40

Heart

Question 41

For calcium, pick answers related to ______ problems

Answer 41

Muscle

Question 42

Choose the electrolyte ______________ is nerve or skeletal involvement

Answer 42

CALCIUM

Question 43

Your patient has diarrhea … Which one of the following electrolyte imbalances causes diarrhea?

Answer 43

Hyperkalemia

Question 44

What dpes hypernatremia looks like? S/Sx?

Answer 44

Dehydration, high Na in the blood vessels pulls flui from body into the vasculature - hot, fluched, dry skin, thready pulse, rapid HR… Give fluid - associate “E” in hypernatremia with DEhydration

Question 45

What does Hyponatremia looks like? What are S/Sx?

Answer 45

Overload - crackles, distended neck veins…. *Associate “O” in hyponatremia with Overload

Question 46

What is the nursing diagnosis for hyponatremia?

Answer 46

Fluid Volume Excess

Question 47

What is the Tx for HYPONATREMIA

Answer 47

Fluid restriction & Lasix

Question 48

What is the Tx for Hypernatremia

Answer 48

Give fluid

Question 49

In addition to a high potassium, what other electrolyte abnormality can be seen in DKA?

Answer 49

Sodium (Na) /Hypernatremia

Question 50

Review—Think dehydration or Fluid overload SIADH: Hyponatremia SIADH: DI: HHNK:

Answer 50

SIADH: Hyponatremia (dehydration) DI: Hypernatremia (fluid overload) HHNK: Hypernatremia (dehydration)

Question 51

What is the universal sign of all electrolyte imbalance?

Answer 51

Muscle weakness = Paresis

Question 52

What are the early sign of any electrolyte disturbance?

Answer 52

Numbness and tingling = Paresthesia Circumoral paresthesia = Numbness and tingling around the lips

Question 53

What is the rule in administration of Potassium IV

Answer 53

NEVER GIVE PUSH

Question 54

How do we treat HYPERKALEMIA

Answer 54

• The fastest way to lower potassium level is to o Give D5W and regular insulin to decrease potassium o This will drive the potassium into the cell and out of the blood o Temporary solution but quick • Kayexalate is long-term solution o Through enema or ingestion, Kayexalate exchanges potassium for sodium o Potassium is eliminated through feces and pt becomes hypernatremic o Hypernatremia is managed with IV fluid administration o The downside is it takes hours to work • To solve this problem o Give D5W, Regular insulin, and Kayexalate and the same time D5W and Regular insulin work instantly Kayexalate works in a few hours—K Exits Late

Question 55

Of all electrolyte imbalance, high ________ is the most problematic High ________ can stop the heart

Answer 55

POTASSIUM

Question 56

What is normal potassium levels

Answer 56

3.6 to 5.2

Question 57

A sign of neuromuscular irritability due to low calcium

Answer 57

Chvostek sign

Question 58

Hand spasm with BP cuff due to low Calcium

Answer 58

Trousseau

Question 59

What are signs of hypocalcemia

Answer 59

Chvostek sign (tap the cheek) Trosseau (inflate BP) Agitation Irritability 3+ 4+ reflexes spasm seizure Tachycardia

Question 60

What are released in thyroid

Answer 60

Thyrpid hormones Replace w: Levothyroxine if Hypothyroidism /myxedema coma

Question 61

What are Adrenal hormones?

Answer 61

1. Epinephrine 2. Cortisol (high blood glucose) 3. Aldosterone (high Sodium, low Potassium)

Question 62

A.k.a. Hypoadrenalism or adrenal insufficiency

Answer 62

Addison Disease

Question 63

Under secretion of steroids(stress hormone) ((they are a time bomb!)) S/SxL pts are hyperpigmented (very tan) They do not adapt to stress (decrease of perfusion to the brain)

Answer 63

Addison Diseases (hypoadrenalism/ adrenal insuffeciency)